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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2011-2671

2. Registrant Information.

Registrant Reference Number: PROSAR Case 1-26095200

Registrant Name (Full Legal Name no abbreviations): The Hartz Mountain Corporation

Address: 400 Plaza Drive

City: Secaucus

Prov / State: New Jersey

Country: USA

Postal Code: 07094-3688

3. Select the appropriate subform(s) for the incident.

Domestic Animal

4. Date registrant was first informed of the incident.


5. Location of incident.

Country: CANADA

Prov / State: ONTARIO

6. Date incident was first observed.


Product Description

7. a) Provide the active ingredient and, if available, the registration number and product name (include all tank mixes). If the product is not registered provide a submission number.


PMRA Registration No. 25621      PMRA Submission No.       EPA Registration No.

Product Name: UltraGuard Flea Tick Collar for Cats

  • Active Ingredient(s)

7. b) Type of formulation.

Application Information

8. Product was applied?


9. Application Rate.


10. Site pesticide was applied to (select all that apply).

Site: Animal / Usage sur un animal domestique

11. Provide any additional information regarding application (how it was applied, amount applied, the size of the area treated etc).

To be determined by Registrant

12. In your opinion, was the product used according to the label instructions?


Subform III: Domestic Animal Incident Report

1. Source of Report

Animal's Owner

2. Type of animal affected

Cat / Chat

3. Breed


4. Number of animals affected


5. Sex


6. Age (provide a range if necessary )


7. Weight (provide a range if necessary )



8. Route(s) of exposure


9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

>8 hrs <=24 hrs / > 8 h < = 24 h

11. List all symptoms


  • Eye
    • Symptom - Other
    • Specify - "pupillary reaction odd"
  • Nervous and Muscular Systems
    • Symptom - Bizarre behaviour
    • Symptom - Abnormal posture
    • Symptom - Difficulty getting up

12. How long did the symptoms last?

Unknown / Inconnu

13. Was medical treatment provided? Provide details in question 17.


14. a) Was the animal hospitalized?


14. b) How long was the animal hospitalized?

15. Outcome of the incident


16. How was the animal exposed?

Treatment / Traitement

17. Provide any additional details about the incident

(eg. description of the frequency and severity of the symptoms

1-26095200- The reporter, a pet owner, indicates her animal was exposed to an insecticidal product containing the active ingredient tetrachlorvinphos. The pet owner stated she applied the product, a flea and tick collar labeled for use on cats, on her two cats last evening. She reports she has used the same product historically on the same animals with no adverse event. The morning of her initial contact the pet owner stated one of her cats, a seven year thirteen pound animal ( Subform III, #1), was observed walking in circles staring at the wall, laying down, down in the haunches, and with an 'odd pupillary reaction'. The pet owner had removed the collar and rinsed the area of application. Through further questioning it was discovered the pet owner had also applied a concentrated permethrin product to her dogs the night before and the affected cat may have had access to a source of ethylene glycol (antifreeze). The pet owner was advised the collar use as labeled would not be expected to elicit the signs seen. She was advised concentrated permethrin products can elicit neurologic signs in cats and are ill advised in households where cats share space with dogs. The caller was also advised ethylene glycol is highly toxic to cats and may elicit the signs seen if ingested. Cats are known to seek out and ingest ethylene glycol when allowed access. The pet owner was advised to seek immediate veterinary assistance. The pet owner was advised of registrant supported cholinesterase testing and pyrethroid testing. The pet owner called back spontaneously three days later indicating the signs are persisting. She was advised she must seek veterinary care to determine the cause of the animal¿s illness and appropriate care. No further information is available.

To be determined by Registrant

18. Severity classification (if there is more than 1 possible classification


19. Provide supplemental information here